One thing everyone should know about pain

Pain has been defined as a ‘complex constellation of unpleasant sensory, emotional and cognitive experiences provoked by real or perceived tissue damage and manifested by certain autonomic, psychological, and behavioral reactions’.[1] Simply put, pain is essentially a defence mechanism: it is a warning signal telling us that something is wrong. All over the body there are sensory neurons known as nociceptors that alert us to potentially damaging stimuli. However, pain does not come from nociceptors; all pain comes from the brain.

The way our brain processes pain is complex, but we don’t need to know the detailed workings. There is one thing, however, that we should know about pain:

We can shift our perception of pain, and this shift will allow us to use pain in a positive manner.

Before we can initiate this shift in our perception of pain, we need first to have a basic understanding of how we perceive pain. Perhaps the easiest way of explaining this is to look at, and compare, the pain suffered by two very different groups – athletes and patients – and start by asking a very simple question:

Why is the pain suffered by patients struggling with serious illness feared and hated, yet similar, or often higher, levels of pain suffered by athletes frequently loved and sought out?

Some may argue that you can’t compare the two groups as the pain felt by the athlete is easier to bear because he or she knows it is short lived. But for countless athletes there is only a break in pain, as their training requires them to endure extreme pain on a daily basis.

One of the key factors for the difference between the two groups is their interpretation of the warning signals.

An excellent example of how interpretation of warning signals directly affects the actual pain we feel is explained by Lorimer Moseley during a TEDx seminar in Adelaide entitled ‘Why things hurt’.[2] In brief, the level of pain we feel relates directly to the level of danger we perceive from it.

In the following example, for simplicity of explanation, the athlete is female and the patient male.

The athlete on a hard training run knows this pain; she does not fear it because she has learnt that all it can do is make her stronger. Aware that a training run will only help her reach her goal if she experiences this pain, she wants the pain, and will push herself harder, seeking it out. The top athletes take this approach to the extreme: the former world champion boxer, Mohammad Ali, stated that he had to experience a level of pain before he considered his training session to have even started.[3]

In contrast, the patient believes pain is a warning that damage, has, or is, taking place. He desperately wants it to stop and becomes increasingly distressed by it, focussing on it and, as a result, increasing the intensity of the warning signals, thereby increasing the pain itself.

Another factor responsible for the difference between the two groups is the effect that enduring pain has on self-worth and self-belief.

For athletes, the act of putting themselves through extreme pain increases self-belief and self-worth. It’s a natural reaction as each training session is a challenge, and each time athletes meet, and exceed, that challenge by enduring greater pain, the greater the sense of control, and the greater the confidence in themselves and their physical abilities.

In contrast, the more pain a patient endures, the more there will be a tendency to feel the illness is taking over, and that control is being taken away. That individual patients can do nothing about this – particularly if medication is having little effect – can result in their adopting a victim-like mentality, with the pain steadily increasing, as self-worth and self-belief decline. 

The pain is similar for both groups, but how it is interpreted is making a difference to far more than the warning signals.

The first step for the patient in changing his perception of pain is to establish that everything medical is being done to ensure the root cause is identified and appropriate action taken (correct diagnosis is crucial). The second step is to ensure that appropriate pain relief is given. If the patient does all he can to take these steps, then there is nothing more that personally can be done about the pain (there is no need to pay attention to the existing warning signals of illness/physical trauma as they have been passed over to medical experts to deal with). All that remains is the pain itself. Acknowledging this then allows the understanding that the pain now becomes, for the individual patient, a challenge, and with that challenge comes a decision as to how the pain is faced, how it is endured. In the understanding that there is now a choice, the patient regains a level of control.

Unlike the athlete, the patient won’t see pain as way to increase performance, but by shifting his perception of it, increased self-belief and self-worth are possible. This could be crucial in getting through the day, but the patient can also use these increases in self-belief and self-worth to fight for some other goal in the future.  

The more the patient believes in himself, the more he is able to believe in recovery.

Research on the placebo effect provides substantial evidence that the greater our belief in recovery, the more our body works towards recovery.

What then is the mental process for the patient to take something from the pain, allowing it to be used?

Firstly, the power of belief has to be acknowledged. This may require some basic research into the placebo effect. It also has to be understood how important self-belief is in this ability to believe. Then some form of mental action needs to be taken – like visualization – to help with the belief in recovery. It doesn’t have to be recovery specifically that is visualized; just as long as there is a significant goal that needs self-belief and self-worth in order for this goal to be attained.

The patient then has to stop resisting the pain, to stop wishing it would end; instead accepting the pain as a challenge and that he is up to the challenge – a sense that it can, and will, be handled. As soon as this fact is acknowledged, the fear of pain is lost. This is the point where the relationship with pain changes, and the patient can begin to focus attention on what is being taking from the pain: that by enduring it without fear, self-worth and self-belief are being built, and the greater the pain, the greater the potential to achieve individual goals.

Using this approach is not easy. The pain can, and will, hurt us, but the more it does, the stronger we can become mentally. It will work this way as long as we believe it will. By believing we are taking something positive from pain, we are. 

[1] Terman G.W. and Bonica J.J. (2003) ‘Spinal mechanisms and their modulation’. In: Loeser J.D., Butler S.H., Chapman C.R. and Turk D.C. eds. Bonica’s Management of Pain. 3rd ed. Philadelphia, Pennsylvania, USA: Lippincott Williams and Wilkins; p.73

[2] Moseley, L. (2011) [Online lecture] ‘Why things hurt’, TEDx Program, Adelaide, November, Accessed YouTube November 2011: https://www.youtube.com/watch?v=gwd-wLdIHjs

[3] Ali, M. and Durham, R. (1975) The Greatest: My Own Story, New York, Random House

Anton FitzSimons is a former soldier and award-winning business graduate. To combat the fear and loss of control he experienced with illness, he developed a strategy to exploit the placebo effect. Extreme Mental Combat is characterized by its simplicity and use of ruthless tactics to attain, and maintain, total belief in a desired future. The use of pain to build self-worth and self-belief is seen as a key part of the strategy and FitzSimons’s experiences of using pain are described in detail in his fourth book on the strategy: Extreme Mental Combat (2015).